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Body Art Inspect* Report <br /> Date: e;/GLZO <br /> : San Joaquin County Environmental Health Department Program <br /> N 1 ; 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Pao 5 4 40 no <br /> " (209)468-3420 <br /> Program <br /> C�� FOR0'P www.sjoqv.ora/ehd Element: L`j <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Breanna Ostrander(BBP exp.2/6/21)Permit and <br /> PRO544032 BBP posted <br /> Rosalva Zapata(BBP exo.2/5/21)Permit and BBP <br /> PR0544033 posted <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f)—Sterilization certificates and invoices were not provided for the equipment <br /> used.A sterilization certificate is needed for needles/blades with the lot#E06368061 RL(Rosalva), MADLUW lot# <br /> MB19200816 (Breanna)and IP cartridge lot#90801A. <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b)— <br /> The paper towel dispenser in Rosalva's procedure room did not contain paper towels. Place paper towels in the paper <br /> towel dispenser, provide photographic evidence to the EHD. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303—The client consent forms did not have a copy of client Identification. Keep a copy <br /> of client's identification with the consent form. <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b)—The aftercare instructions did not have all the requirements listed in Form B.Corrected on <br /> site. <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313—The IPCP was not <br /> available for review. Provide a copy of a completed IPCP to the EHD, keep a copy of the IPCP at the site at all times. <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313—Employee training <br /> records were not available.All practitioners are required to be trained on the IPCP. Submit evidence of training to the <br /> EHD. <br /> UNLESS OTHERWISE NOTED, CORRECT ALL VIOLATIONS BY February 20, 2020. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />